Class Request Form

Instructor name *

School/Organization *

Address

Address 2

City

State

ZIP code

Phone *

Email *

Course title *

Number of students *

Number of faculty & staff *

Grade level of students (check all that apply) *

Please provide three possible dates and times for your class in order of preference:

First preference *

Month

Day

Year

Start time *

Hour

:

Minute

am

pm

End time *

Hour

:

Minute

am

pm

Second preference *

Month

Day

Year

Start time *

Hour

:

Minute

am

pm

End time *

Hour

:

Minute

am

pm

Third preference *

Month

Day

Year

Start time *

Hour

:

Minute

am

pm

End time *

Hour

:

Minute

am

pm

Which collection(s) would you like to use in your class? *

Please list any specific materials that you have already identified that you would like to use:

Please provide a brief description of your learning goals and types of materials you would like to use: *

Would you like to add a guided tour of the building to your visit?

Yes

No

Please contact Hannah Weisman, Director of Education, at 617-720-7617 or weisman@bostonathenaeum.org if you have any questions.

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